José Vilar and Friends Case 33 (Update: Solution)
Hello Friends,
here I am trying to initiate a new course with fresh cases. I hope that all of you are well, and doing your best during this horrible pandemia.
My first case was shown to me a couple of days ago by Dr Teresa Lago Muñoz, a young radiology resident at Hospital Dr Peset.
Dr Lago tells me that this is a 48 year-old man, heavy smoker for the last 30 years.
What do you think? What would you do? (No previous images were available).
Click here for the answer
This first case is very simple to warm up for future more complicated cases but yet this type of cases are important in our practice. Let´s see…
Solution.
The lateral chest radiograph ( well seen by some of you) shows a nodule overlying the spine ( white arrow). In view of the patient´s history of smoking for many years, a suspicion of possible lung cancer was raised. In this case, without previous images, a chest CT is the procedure of choice.
The CT did not show any pulmonary nodules/masses. But a large osteophyte in the right costovertebral joint at T5 was identified.
This is not an uncommon cause of false pulmonary nodules, especially in the lateral projection
Osteophytes are so common and variable that may often confuse us. Remember to look at previous images if available and pay attention to the spine and other skeletal structures.
False pulmonary nodule (white arrow) due to osteophytes in the first costo-chondral junction.
I see a reticulo-nodular pattern and could be a solid nodule in the lateral view. I think it would be a good idea to make a chest CT to search for smoking related lung diasese (Langerhans histiocitocys?) and lung cancer.
very small pulmonary opacities are seen in the right mid zone periphery, in the third anterior intercostal space, with radiating linear strand to the hilum. nodular opacity seen lateral view overlying the spine
the right hilar prominance-? vascular
both costophrenic angles are free.
cardiac size normal
suspicion of lytic lesion in the medial end of the left clavicle
ct may help to rule out any lung nodule like peripheral SPN, AVM OR NEUROFIBROMA
Chest x ray shows well defined round opacity with preserved overlying lung marking at retro cardiac region and overlying the intact vertebral body.
Dax posterior mediastinum mass, neurogenic tumor, adenopathy or esophageal cancer, lung cancer